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Certainty through research into root causes

Does your child walk on tiptoes? With the Toe Walking Test by POMARINO, you get a reliable diagnosis and certainty as to whether there is a genetic cause for your child to be walking on tiptoes. Thus you’ll find the right therapy for your child – to prevent consequential damage.

Toe walking in children

Better understanding
gait abnormality

Toe Walking Test

by Pomarino

Determine the cause – and find the right treatment.



What comes after the test?

Important information at a glance

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About us



What spurs us on

We at Pomarino Human Genetics Agency (PHGA) help affected parents to discover the causes for their child walking on tiptoes. Because only if the diagnosis is made on time and the cause is determined correctly a tailor-made therapy can be chosen so as to avoid consequential damage. This is why we developed the Toe Walking Test by POMARINO

Co-founder and namesake of the Pomarino Human Genetics Agency is David Pomarino, a recognised expert in the field of toe walking in children. He won international recognition for his long-term interdisciplinary work on the diagnosis, classification and therapy of the clinical picture. In 2003, Pomarino established a practice for children with gait abnormalities in Hamburg, Germany.


From the Hamburg location, PHGA, founded by David Pomarino, provides genetic testing for toe walkers throughout the world.

“With the help of the Toe Walking Test, we are able to direct therapies better.“

David Pomarino

David Pomarino

David Pomarino (born 14 October 1975 in La Paz, Bolivia) is a German physiotherapist and entrepreneur of Bolivian heritage. He engages with the research and therapy of gait abnormalities in children.

  • A member of the German Association for Physiotherapy

  • Advisory member of the professional journal “päd – Praktische Pädiatrie (Practical Pediatrics)”

  • More than 70 publications on toe walking


ISPO World Congress 2010Leipzig Germany




Honorary doctorate from the Bolivian Medical Association “Colegio Médico de La Paz” as an “Illustre Amigo”.


Ambassador of the Children’s Fund “UNICEF for Bolivia"



Nominated for the "German Medical Award“ 2019


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Toe walking in children

Symptoms and initial assessment

Toe walking in children is a comparatively frequent deviation from normal gait patterns. Especially when learning to walk, many children first walk on their tiptoes. However, in most cases, they stop doing it after a certain period of time. It is therefore difficult for you as parents to recognise whether treatment is necessary. If you observe your child walking on the forefoot for over 50 percent of the time and for more than six months, it is time to act to prevent consequential damage.

Problems in day-to-day living and possible consequential damage

Children who walk on their tiptoes usually have less stamina and strength. In addition, their balance is restricted; they fall more often and are simply not “light on their feet”. And: The gait abnormality may have a negative impact on the child’s mental development. If toe walking is not treated, it can have after-effects far into adulthood. They include foot deformities such as cavus foot or flat valgus foot, movement restrictions in the upper ankle as well as back pain and knee pain.


Diagnosis and causes

Toe walking may be a symptom of a disease of the central or peripheral nervous system or the muscular system. If this disease can be ruled out for your child, your child suffers from habitual toe walking that may be genetic in nature.

We make the corresponding diagnosis with the Toe Walking Test by POMARINO. After the test, the results should be discussed with a qualified specialist as part of a genetic consultation.

Toe walking and genetics

Habitual toe walking used to be seen as a disease with an undiscovered cause. Together with renowned human geneticists, David Pomarino has made his mark for establishing a new perspective: Several genes were identified in numerous analyses that are linked to toe walking. The Toe Walking Test by POMARINO was based on these new findings; with this test a comprehensive diagnosis from an unexplained cause can be made.

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Do you have any questions?

You will probably find the right answer in our FAQs.

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Toe Walking Test


With the Toe Walking Test by POMARINO, we determine the reason for your child’s toe walking. If a genetic cause is present, the test will detect it, so the best individual therapy can be found – and your child can be spared unnecessary, costly treatments or even unnecessary surgery.

1. Order

a test kit

Order your personal test kit via our online shop.

2. Take

a swab

Use the sterile cotton swab to take a sample from the inside of your child’s mouth. Repeat the procedure with the extra cotton swab.

3. Send

us the sample

Send the sample you have taken back to us. In the laboratory, the sample will be thoroughly analysed.

4. Receive the results

You will receive the result in about six to eight weeks.

Voices of parents

“My son’s genetic test has shown us that his toe walking is not caused by a genetic mutation.

I find that quite reassuring.” 

—  Nadine W., Bremen

Which therapy is the right one?


The treatment of toe walking is mainly determined by its cause – and by the answer to the question of which therapies are the most gentle for your child. This includes the pyramid insoles developed by David Pomarino. They create a clearly noticeable pressure as soon as your child tries to walk on tiptoes. The insoles “remind” the children, so to speak, to put down their entire foot. For around 80 percent of the affected children, the pyramid insoles suffice in reducing toe walking in the long term. Other therapeutic options include night-time positioning splints; supplementary treatment with botulinum toxin (Botox); as well as a minimally invasive procedure, if required.
In the case of positive findings, we recommend an online consultation with the practice regarding gait abnormalities, for which we will gladly arrange an appointment.

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